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Critical Analysis of Radiographic and Patient Reported Outcomes Following Anterior/Posterior Staged vs. Same Day Surgery in Patients Undergoing Identical Corrective Surgery for Adult Spinal Deformity – Published Article

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The article is a retrospective cohort study that compared staged procedures to same-day interventions for the treatment of adult spinal deformity (ASD). The study aimed to identify the optimal time interval between staged surgeries. The researchers found that staged procedures resulted in significant improvement in radiographic measures and superior patient-reported outcomes compared to same-day procedures. They also found that an interval of at least three days between staged procedures was associated with better outcomes in terms of Global Alignment and Proportion (GAP) score proportionality. This study fills a gap in the literature regarding the timing and effects of the interval between stages in spinal deformity surgeries

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : most experienced sugical centre in London

Published article

CONCLUSIONS: This investigation is among the first to compare multicenter staged and same day surgery anterior/posterior adult spinal deformity patients fused to ilium using propensity-matching. Staged procedures resulted in significant improvement radiographically, reduced ICU admissions, and superior patient reported outcomes compared to same day procedures. An interval of at least three days between staged procedures is associated with superior outcomes in terms of GAP score proportionality.

Lumbar Fusion Surgery Expert. Best Spinal Surgeon UK
Spine (Phila Pa 1976). 2023 Jul 13. doi: 10.1097/BRS.0000000000004774. Online ahead of print.ABSTRACTSTUDYDESIGN: Retrospective cohort study of a prospectively collected multi-center adult spinal deformity (ASD) database.OBJECTIVE: To compare staged procedures to same-day interventions and identify the optimal time interval between staged surgeries for treatment of ASD.BACKGROUND: Surgical intervention for ASD is invasive and complex procedure,

Spine (Phila Pa 1976). 2023 Jul 13. doi: 10.1097/BRS.0000000000004774. Online ahead of print.

ABSTRACT

STUDYDESIGN: Retrospective cohort study of a prospectively collected multi-center adult spinal deformity (ASD) database.

OBJECTIVE: To compare staged procedures to same-day interventions and identify the optimal time interval between staged surgeries for treatment of ASD.

BACKGROUND: Surgical intervention for ASD is invasive and complex procedure that surgeons often elect to perform on different days (staging). Yet, there remains a paucity of literature on the timing and effects of the interval between stages.

METHODS: ASD patients with two-year (2Y) data undergoing an anterior/posterior (A/P) fusion to the ilium were included. Propensity score matching (PSM) was performed for number of levels fused, number of interbody devices, surgical approaches, number of osteotomies/three-column osteotomy (3CO), frailty, Oswestry Disability Index (ODI), Charlson Comorbidity Index (CCI), revisions, sagittal vertical axis (SVA), pelvic incidence-lumbar lordosis (PI-LL), and UIV to create balanced cohorts of Same-Day and Staged surgical patients. Staged patients were stratified by intervening time-period between surgeries, using quartiles.

RESULTS: 176 PSM patients were included. Median interval between A/P staged procedures was 3 days. Staged patients had greater operative time and lower ICU stays postop (P<0.05). At 2Y, staged compared to same day showed a greater improvement in T1 slope - cervical lordosis (TS-CL), C2 sacral slope (C2SS), and SRS-Schwab SVA (P<0.05). Staged patients had higher rates of minimal clinically-important difference (MCID) for 1Y SRS-Appearance and 2Y physical component summary (PCS) scores. Assessing different intervals of staging, patients at the 75th percentile interval showed greater improvement in 1Y SRS Pain and Total postop as well as SRS Activity, Pain, Satisfaction, and Total scores (P<0.05) compared to patients in lower quartiles. Compared to the 25th percentile, patients reaching the 50th percentile interval were associated with increased odds of improvement in Global Alignment and Proportion (GAP) score proportionality (9.3[1.6-53.2], P=0.01).

CONCLUSIONS: This investigation is among the first to compare multicenter staged and same day surgery anterior/posterior adult spinal deformity patients fused to ilium using propensity-matching. Staged procedures resulted in significant improvement radiographically, reduced ICU admissions, and superior patient reported outcomes compared to same day procedures. An interval of at least three days between staged procedures is associated with superior outcomes in terms of GAP score proportionality.

PMID:37450674 | DOI:10.1097/BRS.0000000000004774

The London Spine Unit : most experienced sugical centre in London

Read the original publication:

Critical Analysis of Radiographic and Patient Reported Outcomes Following Anterior/Posterior Staged vs. Same Day Surgery in Patients Undergoing Identical Corrective Surgery for Adult Spinal Deformity

Sciatica My mother was in absolute agony for more than 3 months due to sciatica. It just came out of nowhere and took her out of action. From working full time she went straight to being bed bound and unable to carry out simplest of actions.The pain was 9/10 and she was bed bound for those three months. Multiple trips to A&E and GP and they wouldn't class it as an emergency therefore they wouldn't do anything about it other than upgrading the painkillers which did next to nothing for my mother. I couldn't bear to watch my mother sleeping on A&E bench in pain for 7 hours, just to be told by doctors that she wouldn't be kept in. I remember her joining her hands and begging the doctors to stop the pain which broke my heart. I then started doing research on google and London spine unit came up with Dr Mo AKMAL's profile and review. First meeting with Dr AKMAL was via ZOOM as my mother was bed bound. Dr AKMAL spoke to me and my mom and told us that this is nothing to worry about and that the pain would be 100% gone.Dr AKMAL assured us to visit the hospital so he could physically inspect my mother and give us the best solution. One trip to the london spine unit and Dr AKMAL advised us that the best solution would be to carry out Minimally invasive disectomy. Dr AKMAL advised that due to my mother being bed bound for a while, steroid injection might not give the result that my mother wishes. Dr AKMAL was very confident and showed us some videos from other patients who had gone through the same ordeal. The biggest thing i noticed between before and after was the smile on the patients face. Dr AKMAL was constantly assuring my mother throughout the meeting that he would take care of her pain and gave her 100% confidence that the result would be delivered.He promised her that she would be walking pain free the same day after the operation. Before the operation Dr GURUNG was consulted multiple times and he also was very helpful. Right after the surgery, as Dr AKMAL promised, my mother was walking and the biggest thing was that the pain was gone. My mother had forgotten to smile for three months and there i saw her smiling again. Dr AKMAL and Dr GURUNG gave us brilliant aftercare and informed us that just give them a ring if there was any issue. Its been several weeks now and my mother is heading towards complete recovery without any issues. The pain is completely gone and anyone who is reading this going through the same horrible sciatica pain you must come and see Dr AKMAL. Thank you Dr AKMAL and your whole team for helping my mom achieve this pain free life.

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Spine (Phila Pa 1976). 2023 Jul 13. doi: 10.1097/BRS.0000000000004774. Online ahead of print.ABSTRACTSTUDYDESIGN: Retrospective cohort study of a prospectively collected multi-center adult spinal deformity (ASD) database.OBJECTIVE: To compare staged procedures to same-day interventions and identify the optimal time interval between staged surgeries for treatment of ASD.BACKGROUND: Surgical intervention for ASD is invasive and complex procedure
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